Provider Demographics
NPI:1073229704
Name:BALLUE, MOLLY KAY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KAY
Last Name:BALLUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 W ELM RD
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-6751
Mailing Address - Country:US
Mailing Address - Phone:402-520-0531
Mailing Address - Fax:
Practice Address - Street 1:320 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2957
Practice Address - Country:US
Practice Address - Phone:402-223-1512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant